                       /\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\
                       \       LaPimp  Registration Form       \
                        \/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/

FIRST 100 registered users receive a free registration code for
LaWho.

I would like to register LaPimp for $30.00 dollars.

Payment is enclosed.  _______ Check   ______ Money Order

If you would like to pay with credit card, please call voice
at 407-348-3386. You will get your registration number right
away. Please note that if you use a credit card, the name on
the billing will be Express Computers.

See below to see how to get your registration number.

Name     : __________________________________________________________


Address  : __________________________________________________________
           __________________________________________________________
           __________________________________________________________
           __________________________________________________________
           
City     : _______________________

Country  : ______________________

Province or State ___  Zip _____-____ or ___-___ (Canada)

BBS Name : ___________________________________________

TYPE THE BBS NAME EXACTLY AS IT APPEARS IN YOUR WILDCAT REGISTRATION
					(case is IMPORTANT)

BBS Phone Number (_ _ _) _ _ _ - _ _ _ _

Home Number (_ _ _) _ _ _ - _ _ _ _

Please write any comments or sugestions you might have.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Send check or money order for 30$ (U.S. funds) to :

    Express Computers
    P.O. BOX 430415
    Kissimmee, Florida
    34743-0415

If you would like me to call you with your registration number, leave
a number to call and the best time to call. Please include $1.00 to
cover the phone call.

If you would like to call me, call 407-348-3386 and I can give you the
number over the phone. Please leave a password below so that I will
know that it is you.

Password _____________________

If you would like to call our board and get the number, please fill
out the information below and I will create an account for you and
leave you mail with the code.

          Name:
       Address:
          City:
   PhoneNumber:
      Password:
      RealName:
 Date of Birth:

If you would like us to mail you the registration, leave your mailing address
below.




Thank you so much for registering. Please let me know what you think of
the program and any improvements that could be made.

                                                Larry Anderson
  For official
Ŀ
           u
           s
           e
   only
